Patient treatment and progress monitor display

ABSTRACT

A medical information system receives patient data and information from various sources and displays such information in a variety of formats for use by member of a medical team in a hospital, clinic, or office. The system receives patient information from doctors, pharmacists, patient monitoring equipment, testing laboratories, and/or computer databases. Access to selected subsets of patient information is provided by user selection of specific data sets identified by job function selection icons. A member of the medical team can record observations about a patient using key words and phrases which can be supplemented with additional text for customized notation. Multiple types of patient data are selectively displayed simultaneously, and to multiple remote users. The system can access stored data according to user-specified formulae to compute a score or metric which reflects a relationship between various factors, each factor being weighted appropriately according to its significance as defined in the formula. A user can selectively display data in graphic form by “clicking” on a row of tabular data in a tabular region of the display and “dragging and dropping” that row to a graphic display region of the display.

FIELD OF THE INVENTION

[0001] The present invention relates to computerized informationsystems, and more particularly to information systems which can receivepatient data and information from various sources and can display suchinformation in a variety of easily understood formats for use by membersof a medical team in a hospital, clinic or office.

BACKGROUND OF THE INVENTION

[0002] When an individual is admitted as a patient into a hospital,certain information about the patient must be acquired and madeavailable to various members of the hospital staff. Such informationincludes, for example, the patient's identity, address, age andoccupation, next of kin, medical history, conditions for which treatmentis sought, preexisting conditions, and any medical insuranceinformation.

[0003] During a patient's stay in a hospital, written informationrelating to his medical history, doctors' and nurses' observations andremarks, laboratory reports, diagnoses, doctors' orders, prescriptionsand other notes by the medical team, including doctors, nurses,technicians, orderlies and the like, become part of the patient's file.Patients with chronic conditions or who are frequently hospitalized mayhave numerous files of substantial size which contain importanthistoric, as well as current, information. The information that isnecessary to provide a complete picture of the patient includes, forexample, the patient's vital signs, fluid balance, respiratory function,blood parameters, electrocardiograms, x-rays, CT scans, MRI data,laboratory test results, diagnoses, prognoses, evaluations, admissionand discharge notes, and patient registration information. Thisinformation originates from a variety of sources, including the patient,doctors, nurses, monitors connected to the patient, testinglaboratories, the patient's medical records, and hospital administrationrecords.

[0004] A massive amount of information about the patient is thereforegenerated in a relatively short time. Some or all of this information istypically manually recorded in a flowchart which is affixed to thepatient's bed. A disadvantage of manual recordation of such informationis that it is slow and tedious. Consequently, such information issusceptible to later misinterpretation because of illegibility,incompleteness, the sheer volume of information being recorded andtracked, and human error.

[0005] Although critical care environments, such as hospital intensivecare units, trauma units, emergency rooms and the like, are filled withstate-of-the-art electronic equipment for monitoring of patients, thesedevices still do not provide the medical team with a clear and completepicture of the patient and the efficiency of the treatment which he isreceiving. Existing medical display systems are disadvantageous becausethey are incapable of interconnection with a variety of instruments andmonitors, especially if such equipment is made by several differentmanufacturers. In addition, most existing systems save patient data fora relatively short time, often for less than the duration of a typicalpatient's stay in the hospital. Also, existing systems typically cannotaccept the manual entry of information and/or cannot combine suchinformation with data received from other electronic devices.

[0006] Much of the information contained in a patient's files may beabsolutely essential for effective and timely treatment. Unfortunately,this essential information may not be easily retrievable from thevolumes of information in a patient's records. The necessary informationmay be overlooked, or mistranscribed, or entered in an incorrectlocation on the chart. In other circumstances, because of the urgencyassociated with the patient's condition, the medical team may not havetime to search through a patient's file for certain vital information.

[0007] In addition, a patient's treatment plan consists of a series ofinstructions that may change during the course of treatment. In amanually recorded and displayed system, such as a flowchart attached toa patient's bed, it is difficult to ensure that all details of atreatment plan are recorded, and it is difficult to track such manuallyrecorded information. As a result, a patient may receive a treatmentlate, or not at all. Clearly, if the medical team cannot accessessential information about a patient in a timely and complete manner,the quality and effectiveness of the care and treatment of the patientmay be compromised.

[0008] Many hospitals have changed the way in which patients are billedfor services. In the past, patients were typically billed on the basisof days hospitalized. With recent changes in health care management andpractice, patients are now more likely to be billed on the basis oftreatments received. Greater efficiency in the treatment of patients istherefore emphasized. As a consequence, hospitals now scrutinize theeffect of a treatment on a patient more closely, with increasedmonitoring, observation and recordation of the patient's responses totreatment. The increased amount of information that must be recordedabout a patient makes the existing manual-entry system extremelycumbersome and time-consuming for the medical team.

[0009] There exists a need for all data and information obtained fromand about a patient in a hospital to be immediately and selectivelyaccessible to various members of the medical team in a hospital inaccordance with the function performed by those members.

OBJECTS OF THE INVENTION

[0010] An object of the present invention is to obviate thedisadvantages of the prior art.

[0011] Another object of the present invention is to provide a medicalinformation system which displays all types of medical information abouta patient in a variety of easily understood formats.

[0012] Another object of the present invention is to provide a medicalinformation system which receives patient information from a widevariety of sources, such as, for example, doctors, pharmacists, patientmonitoring equipment, testing laboratories, and other computerdatabases.

[0013] Another object of the invention is to provide a medicalinformation system in which access to selected subsets of patientinformation is gained by selection of specific data sets identified byjob function selection icons.

[0014] Another object of the invention is to provide a medicalinformation system which permits a member of the medical team to recordobservations about a patient using key words and phrases which can besupplemented with additional text for customized notation.

[0015] Another object of the invention is to provide a medicalinformation system which presents multiple types of patient datasimultaneously.

[0016] Another object of the invention is to provide a medicalinformation system which can be accessed by more than one user and whichpermits simultaneous viewing of patient information by more than oneuser.

[0017] Another object of the invention is to provide a medicalinformation system which can be updated in real time with additionalpatient information.

[0018] Another object of the invention is to provide a medicalinformation system which permits graphical displays of multiple types ofpatient data using a common time scale.

[0019] Another object of the invention is to provide a medicalinformation system which provides for score computation andidentification of missing parameters or values necessary for successfulcomputation.

[0020] Another object of the invention is to provide a medicalinformation system which provides for active control of peripheraldevices, such as respirators, infusion pumps, intravenous pumps, and thelike.

[0021] Another object of the invention is to provide a medicalinformation system which is capable of storing patient data for at leastthe period of the patient's current hospitalization, and preferably formuch longer periods of time.

[0022] Another object of the invention is to provide a medicalinformation system which is capable of recalling patient data fromrecords created during previous hospital stays.

SUMMARY OF THE INVENTION

[0023] These and other features of the invention will be more fullyappreciated with reference to the following detailed description whichis to be read in conjunction with the attached drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0024] The invention is further described by the following descriptionand figures, in which:

[0025]FIG. 1 shows in block diagram form, a medical information systemembodying the invention.

[0026]FIG. 2A shows an exemplary display screen, illustratingsplit-screen aspects of the invention;

[0027]FIG. 2B shows an exemplary display screen illustrating multipleimage aspects of the invention.

[0028]FIG. 3A shows an exemplary “Physician” display screen; and

[0029]FIG. 3B shows an exemplary “Nurse” display screen.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0030] A medical information system 10 of the present invention is shownin FIG. 1. The system 10 includes a primary display 12, and anassociated display controller 14 and system storage device 16. Thecontroller 14 is coupled to a primary interface nit 20. Keyboard and/orpointing device 22, scanner 24, audio input and/or output device 26 andprinter 28 are all coupled by way of interface unit 20 to the displaycontroller 14. In the preferred embodiment, these elements areestablished by a personal computer such as a Gateway 2000 Pentium Pro™200 Mhz system, programmed to perform the functions described in detailbelow.

[0031] A plurality of patient bedside monitors (such as aHewlett-Packard Model M66 Merlin monitor) and other instruments (such asPuritan-Bennett Model 7200 ventilator), denoted M1, M2 . . . M_(n) inFIG. 1, are coupled by way of separate interface units, I1, I2, . . . ,I_(n) respectively, to the display controller 14.

[0032] In the illustrated embodiment, the various units M1, M2, . . .M_(n), and their associated interface units I1, I2, . . . I_(n), asdescribed in detail below. Together, elements 12, 14, 16, 20, I1, I2, .. . , I_(n) establish a bedside unit, denoted BSU-1 in FIG. 1.

[0033] In the present embodiment, the interface 20 also is coupled byway of a local area network (LAN) 30 to a remote display controller 32,which in turn is coupled to a remote display 34 and a remote storage 36.In other embodiments, the latter coupling may be effected by way of aninterface similar to interface unit 20, which in turn may be coupled tovarious bedside monitors or other instruments.

[0034] The interface unit 20 is also coupled by way of modem 40 and theInternet 50 to another remote display controller 52, which in turn iscoupled to a remote display 54 and remote storage 56. In a similarmanner, this coupling may be effected by way of another interfacesimilar to interface unit 20, which may also couple various bedsidemonitors and other instruments.

[0035] In addition, the interface unit 20 is also directly coupled to aremote display controller 60, which in turn is coupled to remote display62 and remote storage 64.

[0036] A second bedside unit BSU-2 couples units M1, M2 and M_(n),(which may be similar to elements M1″, M2″ and M_(n)″) by way of LAN 30to interface 20.

[0037] In BSU-1, the display 12 generates images in response to a set ofdisplay signals which are generated by display controller 14. Thecontroller 14 is capable of receiving multiple data sets, each data setbeing representative of medical information. The controller 14 includesa user device (keyboard/pointer 22) which is responsive to a userselection action for generating a selection signal. The user device maybe any kind of selection device, for example, a keyboard (with cursorcontrol), mouse, light pen, trackball, touch pad, or voice controlledpointer provided by speech recognition software.

[0038] In the illustrated form of the invention, the selection signalrepresents one of several subsets of the medical information data sets.Each subset is associated with a user job function or a user department.The number of possible subsets of the medical information data sets isgreater than one. The controller 14 is also capable of generatingdisplay signals in response to the selection signal. The display signalsrepresent the subset of medical information which is associated with thegenerated selection signal. The displayed image also corresponds to thesubset associated with the generated selection signal.

[0039] By way of example, the user job functions are selected from thegroup consisting of doctor, nurse, pharmacist, administrator, insurancecoordinator, quality controller, and assistants thereto. The departmentsare selected from the group consisting of medical, pharmacy,administration, finance, and insurance departments. In other forms ofthe invention, additional, or different sub-sets of, user job functionsand departments may be incorporated.

[0040] The data sets include sets of information from the groupconsisting of patient identity and admission information, patientdiagnosis information, patient measurement information, patienttreatment plan information, patient order information, and patienttreatment information. Additional, or different sub-sets of, data setsmay alternatively be incorporated in other forms of the invention.

[0041] As described more fully below, BSU-1 collects data in real timefrom a variety of sources, including electronic monitoring equipmentattached to the patient and in remote laboratories, as well as otherinput devices, such as a keyboard, by which a member of the medical teamcan record observations, notes, orders and the like. Each instrument isinterconnected with the display system with a universal interface devicefor facilitating input and output of information, such as, for example,an RS-232 interface. In the present embodiment, BSU-1 includes aWindows®-type operating system which provides a user-friendly displayscreen with prompts for accessing and entering medical information.

[0042] The medical data and other information of interest to the medicalteam is stored in a personal computer (PC), which processes and displaysthe information in real time in a graphic and/or text display. Variousreports can be generated from the stored data. The user can combinedifferent sets of data from different sources to obtain customizedsummaries of the patient's status and progress.

[0043] In use, a BSU is located near each patient bed in a hospitalward, such as in an intensive care unit (ICU). The BSU is coupled toeach of the electronic monitoring devices attached to the patient, suchas, for example, a respirator, blood pressure monitor, or anelectrocardiograph (referred to as M1, M2, . . . M_(n) in FIG. 1). Inother forms of the invention, active devices, such as infusion pumps canbe coupled to the BSU. In addition, the BSU is connected via interface20 to a distributed electronic database, which may be generated ormaintained by or in conjunction with other departments within thehospital, such as, for example, imaging, hematology, pulmonary,pathology, and various laboratories. The BSU at the patient's bedsidereceives information continuously from each of the devices and isadapted to permit manual entry of information as well.

[0044] Remote data displays (such as displays 34, 52 and 62, or those inBSU-2 and BSU-3, in FIG. 1) are also located at doctors' offices andnurses' stations to permit the medical team to monitor and reviewpatient information and to receive reminders of actions to be taken.Because all information that is generated is stored in a commondatabase, the system permits simultaneous viewing of the information bymultiple users.

[0045] The system provides for the entry and monitoring of action items,such as, for example, orders for drugs or other treatments. Operationalreminders are then generated and transmitted to the medical team. Thesystem further permits entry of confirmatory information by theappropriate member of the team to verify that an order has been carriedout. Compliance with orders is tracked as well, and the display screencan indicate an alarm or other warning indicator which notifies themedical team that an order has not yet been carried out.

[0046] The system further has the capability of providing customizednotations in a patient's file using predefined phrases which can becombined and edited as needed. The use of predefined terminologyeliminates the use of highly specialized or confusing vernaculars in thedescription of a patient's condition.

[0047] The system can additionally perform computations relating to theseverity of a patient's condition. The system can access stored dataaccording to user-specified formulae to compute a “score” which reflectsa relationship between various factors, each factor being weightedappropriately according to its significance as defined in the formula.The system permits the medical team to define and enter formulae forvarious conditions. In addition, the system indicates an inability tocomplete a computation if one or more parameters in a given formula ismissing. The system indicates which parameters are missing and, ifpossible, computes a value for the missing parameter using availableinformation.

[0048] Alternatively, all data in the system can be saved locally ineach BSU in the network. Thus, at least two copies of the data areretained at all times.

[0049] In the illustrated embodiment, reliability is enhanced in thefollowing names. Each BSU in a LAN continuously monitors the integrityof its link to a server. In the event of link failure, incoming data isstored locally at the BSU. Otherwise the data is transferred to aserver, where it is mirrored to a backup store or another server in realtime.

[0050] Use of the system in a hospital can effect a significant savingsin the time spent by the medical team in reviewing and recording patientinformation.

[0051] The system includes various security provisions to ensure theintegrity of the data as it enters the network, and further to ensurethat only authorized persons are able to access the information, enteradditional information and orders, and change data. For example, eachoperator's identity is recorded and associated with each action taken.Operator identity can be encoded, for example, with a multi-digit numberor an alphanumeric code. Second, certain operations are restricted tocertain members of the medical team: for example, only doctors arepermitted to access and enter information relating to prescriptions fordrugs and treatment therapies. Only pharmacists are permitted to accessand enter information relating to the filling of prescriptions. Onlynurses and other technicians are permitted to access and enterinformation relating to administration of drugs and treatments. Third,customized input masks are provided to ensure that the effects of errorsor mistakes are not introduced into the system, such as by the entry ofincorrect or incompatible information. For example, if a doctor enters avalue which is outside a permitted range, an out-of-range messageappears, prompting the user to check the value. Such masks cannot beoverridden by the medical team and therefore ensure the integrity of theinformation in the system.

[0052] Split Screen Drag and Drop Display

[0053]FIG. 2A shows an exemplary screen display showing Vital Signs datafor a patient in both tabular and graphical forms. A user may use thegraphics “button to select graphic-only, tabular-only, orgraphic/tabular (as illustrated) form. When in the latter form, the usercan selectively determine which data is graphed by clicking” on a row oftabular data and “dragging and dropping” that row to the graphic displayregion, where that tabular data is then illustrated in graphic form onthe then-effective time base for the screen. Similarly, to simplify orotherwise customize the graphic display, the user may “click” on one ofthe graphs and “drag and drop” that graph to the tabular region of thescreen, removing that graph from the graphic display region of thescreen. Preferably, the different graphs in the graphic display regionare different colors, and are coordinated with the colors of thebackground for the respective legends for the data in the tabular regionof the display.

[0054] Multiple Image Display

[0055] In general, the multiple image display aspect of the inventionprovides a multiple image medical information system. The display 12 isresponsive to display signals for generating n medical data images in animage field, where n is an integer, and where each of the images is inan associated one of n regions of the image field of display 12. Amultitasking display controller generates the display signals. Thatcontroller includes a data device, a user select device, and a displaysignal generator. The data device generates patient data representativeof patient-related information, including m subsets of the patient data,where m is an integer greater than n. The user select device isresponsive to user action to select k of the m subsets of patient data,where k is an integer greater than and less than or equal to n. Thedisplay signal generator responsive to the user select device forgenerating k of the display signals, each being representative of anassociated one of the selected subsets of patient data and beingassociated with one of the regions of the image field. The resultant kmedical data images correspond to the k selected subsets of patient dataan are displayed on the display 10 in the respective associated regionsof the image field. In one form, at least one of the m subsets ofpatient data is representative of a plot of at least two measuredpatient characteristics as a function of a reference parameter on acommon scale, where the reference parameter is time. Preferably, for onesubset of patient data, the measured characteristics and the referenceparameters are selectively determined by a user, and wherein the data ofat least one of the m subsets of patient data corresponds to measuredpatient characteristics and associated reference parameter values. Themeasured patient characteristics may be from the set consisting of bloodpressure and others, the associated reference parameters are from theset consisting of time and others.

[0056] A screen at display 12, illustrating the ability of the system topresent multiple graphical displays of patient information, is shown inFIG. 2B. The menu bar shows icons MI1, MI2, MI3 and MI4 whichrespectively offer the user a choice of one, two, three or foursimultaneous displays. FIG. 2B illustrates four graphical displaysentitled VITAL SIGNS, RESPIRATION, HEMATOLOGY and BLOOD GASES. Otherdisplays, such as, for example, FLUID BALANCE, FLUID INPUT and FLUIDOUTPUT, or other flow chart parameters, can also be selected. As for thescreen display described in conjunction with FIG. 2A, each of the datasets can be displayed in a variety of formats, including graphical,tabular, bar chart and pie chart formats, with or without split screen.As in FIG. 2A, “drag and drop” may be used to modify and/or customizethe images. In FIG. 2B, the graph in the VITAL SIGNS display includesmultiple traces which represent, respectively, DBP (diastolic bloodpressure), SBP (systolic blood pressure) and CVP (heart rate). The tablebelow the graph includes numerical data in one minute intervals of time.The time scale can be selectively changed by a user for any or all ofthe images.

[0057] The data is presented in a way which maximizes its utility andfacilitates its interpretation by the medical team. Note that a displaymay contain more information than can be seen in a multiple-displaywindow. Each display can be scrolled through independently to review allthe information contained therein, or maximized to fill the entiredisplay screen, by selecting the appropriate icons at the right side andbottom of each display.

[0058] Information is collected in real time. As a consequence, datacollection may occur during the period in which a member of the medicalteam is reviewing a patient's data file. In this instance, a messageappears on the display screen to indicate that a particular data set isbeing updated.

[0059] Job Function Display Screen

[0060] According to the job function display aspect of the invention,the display 12 is responsive to display signals to generate an imagewhich shows one selected view from a set of possible view of the data ina database at system 10. Preferably, the various possible views are eachassociated with a job function of a corresponding set of possible systemusers of system 10. For example, a doctor, by virtue of his or her jobfunction, would generally have an interest in viewing a certain subsetof a patient's data from BSU-1. Similarly, a nurse, by virtue of his orher job function, would generally have an interest in viewing adifferent subset of that same patient's data. FIG. 2A shows an exemplaryscreen having menu choices for each of a “Physician” and a “Nurse”.While not shown in FIG. 2A, other job functions, or department's (suchas pharmacy or lab) for whom displays might be desired, can also havemenu selectors.

[0061]FIG. 3A is an exemplary screen following selection of “Physician”and FIG. 3B shows an exemplary screen following selection of “Nurse”.The screens of FIGS. 3A and 3B show different sets of patient data thatmay be useful for the Physician and Nurse job functions, respectively.With the invention, each of the data sets for the respective jobfunctions may be custom selected by a user, but in general, because ofthe difference in needs for users with the different job functions, thedisplayed data sets will be different.

[0062] In operation, the display controller 14 generates the displaysignals for display 12 in the following manner. Controller 14 receives nsets of data, where n is an integer greater than 1, and where each dataset is representative of medical information. A user device 15responsive to a user action to selectively generate a selection signalrepresentative of one of k subsets of the n data sets, where each of thesubsets is associated with one of k user job functions or departments,where k is an integer greater than one. Controller 14 is responsive tothe selection signal to generate display signals representative of thesubset associated with the generated selection signal, so that the imagecorresponds to the subset associated with the generated selectionsignal. By way of example, the user job functions are selected from thegroup consisting of physician (or doctor), nurse, pharmacist,administrator, insurance coordinator, quality controller, and assistantsthereto, and the departments are selected from the group consisting ofmedical, pharmacy, administration, finance, insurance, epidemiology,human services, and statistical and academic studies departments. Therespective ones of the n sets of data include sets representative ofinformation from the group comprising patient identity and admissioninformation, patient diagnosis information patient measurementinformation, patient treatment plan information, patient orderinformation, patient treatment information.

[0063] The following examples illustrate a particular configuration,although many variants can be used within the scope of the invention.Where user job function is “doctor,” the k subsets are selected from thegroup consisting of patient history, physical examination data, currentdrug data, problem data, orders, progress notes, and summary reports.Where the user job function is “nurse,” the k subsets are selected fromthe group consisting of problem data, care plan, orders, and criticalpathways. Where the user job function is pharmacist, the k subsets areselected from the group consisting of drug orders, drug interactions anddrug reference data. Where the user job function is administrator, the ksubsets are selected from the group consisting of hospitalization days,procedures, and medical staff data. Where the user job functions isinsurance coordinator, the k subsets are selected from the groupconsisting of patient cost data, risk factor data and claim data. Wherethe user job function is quality controller, the k subsets are selectedfrom the group consisting of procedure time data, staff performancedata, and disease/hospitalization data. Where the user department ismedical, the k subsets are selected from the group consisting of patienthistory, physical examination data, current drug data, problem data,orders, progress notes, and summary reports. Where the user departmentis pharmacy, the k subsets are selected from the group consisting ofdrug orders, drug interactions and drug reference data. Where the userdepartment is administration, the k subsets are selected from the groupconsisting of hospitalization days, procedures, and medical staff data.Where the user department is finance, the k subsets are selected fromthe group consisting of patient cost data, procedure cost data, andstaff cost data. When the user department is insurance, the k subsetsare selected from the group consisting of patient cost data, procedurecost data, and staff cost data.

[0064] In one form of the invention, selection of one of the jobfunction selectors invokes a security program which limits access to auser unless a valid job function related code is and/or personalinformation number (PIN) is entered. Further, or alternatively, theaccess control program may control the system to be interactive for oneor more users in a first user set and to be read-only for one or more ofthe selected subsets for one or more users in a second user set. By wayof example, the first user set may include only users having the jobfunction of physicians, and the second user set may include only usershaving the job function of nurse.

[0065] Medical Text Display

[0066] The medical text display aspect of the invention permits a userto readily compose and store anecdotal information. This is effected byentering text in part via a keyboard or speech recognition device, witha user controlled selector which may be used to select one or more textmacro's (or phrases) stored in system 10.

[0067] Generally, the display 12 is responsive to display signals forgenerating text in an image field in display 12. A display controllergenerates the display signals. That controller includes a memory, a userselect device a user text entry device and a display signal generator.The memory includes store data representative of a plurality of discretephrases, each of the phrases being a sequence of words, or abbreviationsor symbols therefor, representative of a medical condition. The userselect device is responsive to a user action to (a) display one or moreof the plurality of discrete phrases, and (b) select a sequence of oneor more of the said phrases and identify text entry pointsrepresentative of desired positions of the phrases in the image field ofdisplay 12. The user text entry device is responsive to user action toselectively determine text to be deleted from the selected sequence ofphrases and additional text to be displayed in the image field atdesired positions in the image field in or between the selected phrases.The display signal generator is responsive to the select device and thetext entry device for generating the display signals, where the displaysignals are representative of the selected phrases and the determinedtext at their respective desired positions in the image field. The userselect device may be one a keyboard, lightpen, mouse, trackball,touchpad and speech recognition text generator.

[0068] Patient Treatment and Progress Monitor

[0069] The system 10 also effects planning of patient treatment andmonitoring of patient progress. The display 12 is responsive to displaysignals to generate text in an image field, where that text isconstructed to define a treatment plan for a patient. For this function,the system 10 uses display controller 14 and storage system 16. Thestorage system (or memory) 16 stores (i) problem data representative ofone or more possible problems associatable with a patient, (ii)treatment goal data representative of one or more treatment goalsassociated with each of the possible problems, (iii) treatment plan datarepresentative of one or more treatment plans associated with each ofthe possible problems, and (iv) patient data. The patient data isrepresentative of the identity of the patient, one or more unresolvedproblems associated with the patient (where each of the unresolvedproblems corresponds to one or more of the possible problems) and zero,one, or more of the treatments associated with each of the unresolvedproblems. The display controller generates the display signals using auser screen entry device which is selectively responsive to user actionto (i) generate a display signal representative of the identity of apatient for whom treatment and progress information is to be displayed,and (ii) generate a display signal representative of selected problemdata corresponding to the unresolved problems for the patient, treatmentgoal data associated with the selected problem data for the patient, andtreatment plan data associated with the selected problem data for thepatient. In one form of the invention, the memory further includesstored cost data associate with the treatment plan data, where the costdata is representative of the cost of effecting said treatment plans. Inthis form, the user screen entry device is selectively responsive touser action to generate a display signal representative of the cost ofthe treatment plan associated with the selected problem data for thepatient. The user screen entry device is responsive to user action togenerate an order signal indicative of a treatment plan to be effected,and for selectively generating a display signal representative of theorder signal.

[0070] Medical Order Display

[0071] The system 10 also provides a display of medical orderinformation. That portion of the system 10 includes the display 12storage system 16, display controller 14 and an order device. Thedisplay 12 is responsive to signals from controller 14 to generate amedical data image. The storage system 16 stores data representative ofpatient orders. The order device is responsive to user action togenerate and store order data in the storage device, where the orderdata is representative of patient orders. That order data for a patientincludes: (i) order data representative of the identity of theprescriber of a prescription, (ii) i.d. data representative of theidentification of said patient, (iii) drug data representative of a drugprescribed for a patient in accordance with the prescription, andadministration data representative of prescribed dosage andadministration times in accordance with the prescription. The displaycontroller generates the display signals. That controller is selectivelyoperative to generate the display signals wherein at least informationrepresentative of the i.d. data, the drug data, and the administrationdata is displayed on said display device. The controller is alsoselectively operative responsive to user action to generate and store inthe storage system, action data representative of an action taken withrespect to the patient and one of said prescriptions, where the actiondata for one of the prescriptions is representative: (a) the delivery ofa drug to the patient, (b) the identify of the drug delivered to thepatient, and (c) the does and time of the drug delivered to the patient.The controller further monitors the order data for one or more of thepatients and detects when action data does not correspond correctfulfillment of the order data and in response thereto, generates adisplay signal representative of an alarm. In conjunction with the saidalarm display signal, an additional alarm may be effected in the form ofan audible alarm, a visual alarm or a data alarm. In some form of theinvention, the order data further includes authentication datarepresentative of a encrypted identifier uniquely associated with theprescription, and the user device requires a user to generate an accessrequest associated with the authentification data for a selected one ofthe prescriptions. In this form of the invention. the display generatorconfirms that the access request corresponds to the authentificationdata for the prescription and upon such confirmation, enables the userdevice to modify the data for said patient, modification of the orderdata is prevented it he event such confirmation is not made.

[0072] Medical Information Calculator

[0073] The system 10 also provides an improved on-screen medicalcalculator which permits interactive control by a user to performcomputations necessary for various medical treatments and/or decisions.The calculator function permits determination of values from datarequired by a BSU from various coupled monitors. Where a requested valuebeing determined cannot initially be accomplished for data presently onhand, the system 10 generates a display so advising the user, and alsoprovides a second level routine that permits computation, or user entry,of values for the “missing” data. The latter routine may be selectivelyperformed to generate the necessary intermediate values. In the eventdata is to present for the second level routine, a similar process maybe performed for a third level routine, and so on. Thus, system 10provides an “intelligent” computations facility.

[0074] In general, the calculator function is performed for a BSU withthe display 12, display controller 14 and storage system 16. The display12 is responsive to display signals to generate a medical data image.The display controller 14 generates those display signals. Thecontroller includes storage for sorting (a) at least two primary levelcomputer programs for selectively effecting the determination of anassociated first level intermediate value fro a plurality of primaryvalues in accordance with a predetermined relationship between theprimary values, wherein at least one of the primary values isrepresentative of a measured parameter of a patient, and (b) zero, oneor more intermediate level computer programs for selectively effectingthe determination of an associated second level intermediate value fromat least one of the first level intermediate values and a primary valuerepresentative of a measured parameter of a patient in accordance with apredetermined relationship between the one of the first levelintermediate values and the primary values. The controller also includesa first memory for storing the primary values other than thoserepresentative of measured patient parameters. The first memory includesdata values representing the primary values other than thoserepresentative of measured patient parameters. A second memory storesthe primary values representative of measures patient values andincludes data values representative of fewer than all of the primaryvalues representative of measured patient parameters. A user device isresponsive to user actions to generate a request signal representativeof a request to display a computed value, where the computed valuecorrespond to a value defined by a combination of the predeterminedrelationship. A processor is responsive to the request signal to invokeone or more of the primary level programs and zero, one or more of theintermediate level programs to effect the computation of the computedvalue. The process is operative when all necessary primary valuesrepresentative of a measured patient parameter are resident in thestorage devices, for generating the display signal whereby the computedvalue is displayed on the display device. The processor also determinesoccasions when a primary value representative of one of the primaryvalues representative of a measured patient parameter is not resident inthe storage device. In response to such determination, the process is togenerate a display signal whereby a prompt identifying the non-residentprimary value is displayed in the display device. The user can thendetermine and enter a value to be used for the non-resident value sothat the desired calculation can be effected.

[0075] The invention may be embodied in other specific forms withoutdeparting from the spirit or essential characteristics thereof. Thepresent embodiments are therefore to be considered in all respects asillustrative and not restrictive, the scope of the invention beingindicated by the appended claims rather than by the foregoingdescription. All changes that come within the meaning and range of theequivalency of the claims are therefore intended to be embraced therein.

What is claimed is:
 1. A multiple image medical information system,comprising: A. a display device responsive to display signals forgenerating n medical data images in an image field, where n is aninteger, each of said images being in an associated one of n regions ofsaid image field, B. a multitasking display controller for generatingsaid display signals, including: i. data device for generating patientdata representative of patient-related information, said patient dataincluding m subsets of said patient data, where m is an integer greaterthan n, ii. user select device responsive to user action to select k ofsaid m subsets of said patient data, where k is an integer greater thanand less than or equal to n, iii. display signal generator responsive tosaid user select device for generating k of said display signals, eachof said k display signals being representative of an associated one ofsaid selected subsets of patient data and being associated with one ofsaid regions of said image field, whereby said k medical data imagescorresponding to said k selected subsets of said patient data aredisplayed on said display devices in the respective associated regionsof said image field.
 2. A system according to claim 1 wherein at leastone of the m subsets of patient data is representative of a plot of atleast two measured patient characteristics as a function of a referenceparameter on a common scale.
 3. A system according to claim 2 whereinsaid reference parameter is time.
 4. A system according to claim 1wherein for said one subset of patient data said measuredcharacteristics and said reference parameters are selectively determinedby a user.
 5. A system according to claim 1 wherein the data of at leastone of said m subsets of patient data corresponds to measured patientcharacteristics and associated reference parameter values.
 6. A systemaccording to claim 1 wherein said measured patient characteristics arefrom the set consisting of blood pressure and others and said associatedreference parameters are from the set consisting of time and others. 7.A medical information system, comprising: A. a display device responsiveto display signals for generating an image, B. a display controller forgenerating said display signals, including: i. means for receiving nsets of data, where n is an integer greater than 1, each data set beingrepresentative of medical information, ii. user device responsive to auser action to selectively generate a selection signal representative ofone of k subsets of said n data sets, each of said subsets beingassociated with one of k user job functions or departments, where k isan integer greater than one, iii. means responsive to said selectionsignal for generating display signals representative of the subsetassociated with said generated selection signal, whereby said imagecorresponds to said the subset associated with said generated selectionsignal.
 8. The system according to claim 7 wherein said user jobfunctions are selected from the group consisting of doctor, nurse,pharmacist, administrator, insurance coordinator, quality controller,and assistants thereto.
 9. The system according to claim 7 wherein saiddepartments are selected from the group consisting of medical, pharmacy,administration, finance, insurance, epidemiology, human services, andstatistical and academic studies departments.
 10. The system accordingto claim 8 wherein the respective ones of said n sets of data includesets representative of information from the group comprising patientidentity and admission information, patient diagnosis information,patient measurement information, patient treatment plan information,patient order information, patient treatment information
 11. The systemaccording to claim 10 wherein one of said user job functions is doctorand said k subsets are selected from the group consisting of patienthistory, physical examination data, current drug data, problem data,orders, progress notes, and summary reports.
 12. The system according toclaim 10 wherein one of said user job functions is nurse and said ksubsets are selected from the group consisting of problem data, careplan, orders, and critical pathways.
 13. The system according to claim10 wherein one of said user job functions is pharmacist and said ksubsets are selected from the group consisting of drug orders, druginteractions and drug reference data.
 14. The system according to claim10 wherein one of said user job functions is administrator and said ksubsets are selected from the group consisting of hospitalization days,procedures, and medical staff data.
 15. The system according to claim 10wherein one of said user job functions is insurance coordinator and saidk subsets are selected from the group consisting of patient cost data,risk factor data and claim data.
 16. The system according to claim 10wherein one of said user job functions is quality controller and said ksubsets are selected from the group consisting of procedure time data,staff performance data, and disease/hospitalization data.
 17. The systemaccording to claim 10 wherein one of said user department is medical andsaid k subsets are selected from the group consisting of patienthistory, physical examination data, current drug data, problem data,orders, progress notes, and summary reports.
 18. The system according toclaim 10 wherein one of said user department is pharmacy and said ksubsets are selected from the group consisting of drug orders, druginteractions and drug reference data.
 19. The system according to claim10 wherein one of said user department is administration and said ksubsets are selected from the group consisting of hospitalization days,procedures, and medical staff data.
 20. The system according to claim 10wherein one of said user department is finance and said k subsets areselected from the group consisting of patient cost data, procedure costdata, and staff cost data.
 21. The system according to claim 10 whereinone of said user department is insurance and said k subsets are selectedfrom the group consisting of patient cost data, risk factor data andclaim data.
 22. The system according to claim 7 wherein said displaycontroller is a programmed digital computer.
 23. The system according toclaim 22 wherein said computer having a window-based operating systemdisplaying icons representative of the respective ones of said jobfunctions and departments, and said user device is a pointing deviceoperatively connected to said computer by way of said operating system.24. The system according to claim 23 wherein said pointing device isselected from the group consisting of keyboard, light pen, mouse,trackball, touchpad, voice controlled pointer.
 25. The system accordingto claim 7 wherein said controller includes access means for selectivelycontrolling operability of said user device by users.
 26. The systemaccording to claim 19 wherein said access means includes means tocontrol said user device to be interactive for one or more users in afirst user set and to be read-only for one or more of said selectedsubsets for one or more users in a second user set.
 27. The systemaccording to claim 20 wherein said first user set includes users havingthe job function of physicians.
 28. The system according to claim 20wherein said second user set includes user having the job function ofnurse.
 29. A medical information system, comprising: A. a display deviceresponsive to display signals for generating text in an image field, B.a display controller for generating said display signals, including: i.memory including stored data representative of a plurality of discretephrases, each of said phrases being a sequence of words, orabbreviations or symbols therefor, representative of a medicalcondition, ii. user select device responsive a user action to: a.display one or more of said plurality of discrete phrases, b. select asequence of one or more of said phrases and identify text entry pointsrepresentative of desired positions of said phrases in said image field,iii. user text entry device responsive to user action to selectivelydetermine text to be deleted from said selected sequence of phrases andadditional text to be displayed in said image field at desired positionsin said image field in or between said selected phrases, iv. displaysignal generator responsive to said select device and said text entrydevice for generating said display signals, said display signals beingrepresentative of said selected phrases and said determined text attheir respective desired positions in said image field.
 30. A systemaccording to claim 29 wherein said user select device is selected fromthe group consisting of keyboard, lightpen, mouse, trackball, touchpadand speech recognition text generator.
 31. A system according to claim29 wherein said user text entry device includes one from the groupconsisting of a keyboard and a microphone.
 32. A patent treatment andprogress monitor system comprising: A. a display device responsive todisplay signals for generating text in an image field, B. a memoryincluding stored: i. problem data representative of one or more possibleproblems associatable with a patient, ii. treatment goal datarepresentative of one or more treatment goals associated with each ofsaid possible problems, iii. treatment plan data representative of oneor more treatment plans associated with each of said possible problems,and iv. patient data representative of a. said patient, b. one or moreunresolved problems associated with said patient, each of saidunresolved problems corresponding to one or more of said possibleproblems, and c. zero, one, or more of said treatments associated witheach of said unresolved problems, C. a display controller for generatingsaid display signals, said display controller including a user screenentry device selectively responsive to user action to: i. generate adisplay signal representative of the identity of a patient for whomtreatment and progress information is to be displayed, and ii. generatea display signal representative of: a. selected problem datacorresponding to said unresolved problems for said patient, b. treatmentgoal data associated with said selected problem data for said patient,and c. treatment plan data associated with said selected problem datafor said patient
 33. A system according to claim 32, wherein said memoryfurther includes stored cost data associated with said treatment plandata, said cost data being representative of the cost of effecting saidtreatment plans, and wherein said user screen entry device isselectively responsive to user action to generate a display signalrepresentative of the cost of said treatment plan associated with saidselected problem data for said patient.
 34. A system according to claim32 wherein said user screen entry device is responsive to user action togenerate an order signal indicative of a treatment plan to be effected.35. A system according to claim 34 further comprising means forselectively generating a display signal representative of said ordersignal.
 36. A system according to claim 33, wherein said memory furtherincludes stored cost data associated with said treatment plan data, saidcost data being representative of the cost of effecting said treatmentplans, and wherein said user screen entry device is selectivelyresponsive to user action to generate a display signal representative ofthe cost of said treatment plan associated with said selected problemdata for said patient.
 37. A medical order information display system,comprising: A. a display device responsive to signals to generate amedical data image; B. storage device for storing data representative ofpatient orders, C. order device responsive to user action to generateand store order data in said storage device, said order data beingrepresentative of patient orders, said order data for a patientincluding: i. order data representative of the identity of theprescriber of a prescription, ii. i.d. data representative of theidentification of said patient, iii. drug data representative of a drugprescribed for a patient in accordance with the prescription, and iv.administration data representative of prescribed dosage andadministration times in accordance with said prescription, D. a displaycontroller for generating said display signals, including: i.selectively operative means for generating said display signals whereinat least information representative of said i.d. data, said drug data,and said administration data is displayed on said display device, ii.selectively operative administrator device responsive to user action togenerate and store in said storage device, action data representative ofan action taken with respect to said patient and one of saidprescriptions, said action data for one of said prescriptions beingrepresentative: a. the delivery of a drug to said patient b. theidentity of said drug delivered to said patient, and c. the dose andtime of said drug delivered to said patient, iii. monitor means formonitoring said order data for one or more of said patients and fordetecting when action data does not correspond correct fulfillment ofsaid order data and in responsive to thereto, generating a displaysignal representative of an alarm.
 38. The system according to claim 37wherein said monitor means generates in conjunction with said alarmdisplay signal, an additional alarm from the group consisting of audiblealarm, visual alarm and data alarm.
 39. A system according to claim 37wherein said order data further includes: authentication datarepresentative of a encrypted identifier uniquely associated with saidprescription, and wherein said user device further includes means forgenerating by a user an access request associated with saidauthentification data for a selected one of said prescriptions, andwherein said display generator includes means for confirming that saidaccess request corresponds to said authentification data for saidprescription and upon such confirmation, enabling said user device tomodify said data for said patient and for preventing modification ofsaid order data otherwise.
 40. A medical information calculator displaysystem, comprising: A. a display device responsive to display signals togenerate a medical data image, B. a display controller for generatingsaid display signals, including: i. storage device for storing: a. atleast two primary level computer programs for selectively effecting thedetermination of an associated first level intermediate value from aplurality of primary values in accordance with a predeterminedrelationship between said primary values, wherein at least one of saidprimary values is representative of a measured parameter of a patient,b. zero, one or more intermediate level computer programs forselectively effecting the determination of an associated second levelintermediate value from at least one of said first level intermediatevalues and a primary value representative of a measured parameter of apatient, in accordance with a predetermined relationship between saidone of said first level intermediate values and said primary values, ii.first memory means for storing said primary values other than thoserepresentative of measured patient parameters, said first memory meansincluding data values representing said primary values other than thoserepresentative of measured patient parameters, iii. second memory meansfor storing said primary values representative of measured patientvalues, said second memory means including data values representative offewer than all of said primary values representative of measured patientparameters, iv. user device responsive to user actions to generate arequest signal representative of a request to display a computed value,said computed value corresponding to a value defined by a combination ofsaid predetermined relationships; v. processor means responsive to saidrequest signal to invoke one or more of said primary level programs andzero, one or more of said intermediate level programs to effect thecomputation of said computed value, and further including: a. meansoperative when all necessary primary values representative of a measuredpatient parameter are resident in said storage devices, for generatingsaid display signal whereby said computed value is displayed on saiddisplay device, and b. means for determining occasions when a primaryvalue representative of one of said primary values representative of ameasured patient parameter is not resident in said storage device, andin response to such determination, operative for generating a displaysignal whereby a prompt identifying said non-resident primary value isdisplayed in said display device.